Provider Demographics
NPI:1104884105
Name:RENO CHIROPRACTIC CLINIC, P.A.
Entity type:Organization
Organization Name:RENO CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-524-5700
Mailing Address - Street 1:1610 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3625
Mailing Address - Country:US
Mailing Address - Phone:316-524-5700
Mailing Address - Fax:316-524-0707
Practice Address - Street 1:1610 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211
Practice Address - Country:US
Practice Address - Phone:316-524-5700
Practice Address - Fax:316-524-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS660003Medicare ID - Type UnspecifiedRENO CHIROPRACTIC CLINIC,